Dr. de Clermont-TonnerrePlastic Surgeon

Paris 16th & Pontoise — Gender-Affirming Surgery

Phalloplasty

FtM reassignment surgery — Paris 16th & Pontoise

Phalloplasty is the major surgical procedure in the FtM masculinisation pathway. It creates a functional neo-phallus enabling standing urination and, in a second stage, penetrative sexual intercourse with an erectile prosthesis.

It is one of the most complex procedures in plastic surgery. It requires significant medical organisation, a multidisciplinary team and strong personal commitment. Dr. de Clermont-Tonnerre accompanies you at every stage of this demanding journey with the full expertise and compassion it requires.

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Step by step

The pathway

01

Preparatory consultations

Several consultations to assess your project, anatomy and expectations. Coordination with multidisciplinary team. ALD 31 file compilation.

02

First stage: Phalloplasty

Under general anaesthetic, duration 6 to 8 hours. Radial flap harvest with integrated urethra. Microsurgical transfer. Simultaneous scrotoplasty.

03

Extended hospitalisation

4 to 6 weeks in clinic to monitor flap vascularisation and manage wound care. Urinary catheter for several weeks.

04

Second stage: Erectile prosthesis

6 to 12 months after phalloplasty. Implantation of penile prosthesis (hydraulic or malleable) enabling penetrative intercourse.

05

Long-term follow-up

Very regular consultations in the first year. Monitoring of prosthesis, urinary meatus and scars. Functional result assessed at 12 to 24 months.

Practical information

Duration (1st stage)
6 to 8 hours
Anaesthetic
General
Hospital stay
4 to 6 weeks
Time off work
2 to 3 months minimum
Reimbursement
ALD 31 (subject to conditions)
Complete pathway
1 to 2 years

Benefits

  • Functional neo-phallus of normal size
  • Standing urination possible
  • Penetrative intercourse (with prosthesis)
  • ALD 31 social security coverage
  • Major reduction in genital dysphoria
  • Comprehensive multidisciplinary support

Risks

  • Partial or total flap necrosis
  • Urinary fistula and stenosis
  • Prosthesis complications (infection, extrusion)
  • Significant scar at forearm (donor site)
  • Lengthy and demanding pathway
  • Multiple possible surgical revisions

French Social Security Coverage

Phalloplasty is reimbursed under ALD 31. It requires documented multidisciplinary follow-up, agreement from the CPAM and significant medical organisation. Dr. de Clermont-Tonnerre assists you in all administrative and medical procedures.

Expected results

Phalloplasty creates a normally sized neo-phallus enabling standing urination and, after erectile prosthesis placement, penetrative sexual intercourse. Tactile sensitivity of the phallus is preserved through microsurgical nerve connection. The impact on quality of life and masculine identity is profound.

It is a lengthy and demanding pathway, but transformative for the vast majority of patients who see it through to completion.

Before and after photos available during the consultation on request.

Frequently asked questions

What is phalloplasty?+
Phalloplasty is the surgical creation of a functional neo-phallus in transgender men (FtM), within a gender reassignment pathway. It is one of the most complex procedures in plastic surgery. The most widely used technique is the radial forearm free flap, which enables the creation of a normally sized phallus.
What are the stages of phalloplasty?+
Phalloplasty is performed in several surgical stages: 1) Creation of the neo-phallus by radial free flap, with an integrated urethra to allow standing urination. 2) Implantation of an erectile prosthesis (penile implant) in a second stage, to enable penetrative sexual intercourse. 3) Scrotoplasty (creation of a neo-scrotum) with testiculoplasty.
Is phalloplasty covered by French national health insurance?+
Yes, within a recognised FtM transition pathway under ALD 31, phalloplasty can be reimbursed by the Assurance Maladie (French national health insurance). Conditions are identical to other trans procedures: multidisciplinary diagnosis, documented follow-up, agreement from the CPAM. This is a major procedure requiring significant medical organisation.
What scars does phalloplasty leave?+
Radial phalloplasty leaves a significant scar on the inner forearm (donor site), generally covered by a skin graft. Healing can take 12 to 18 months. This is the main drawback of this technique, balanced against a high-quality functional and aesthetic result.
What is the recovery time after phalloplasty?+
Recovery is lengthy: 4 to 6 weeks of hospitalisation for the first stage. Time off work is at least 2 to 3 months. The erectile prosthesis is implanted 6 to 12 months after the initial phalloplasty. Full functional recovery can take 1 to 2 years. Regular, prolonged medical follow-up is essential.
What is the difference between phalloplasty and metoidioplasty?+
Both procedures create a neo-phallus but via very different approaches. Phalloplasty uses a skin flap taken from another part of the body (forearm, thigh) to construct a normally sized phallus capable of penetration after prosthesis implantation. Metoidioplasty uses the testosterone-hypertrophied clitoris to create a functional micro-phallus without a distant flap: the procedure is less complex, leaves fewer scars, but results in a smaller phallus that generally does not allow penetration. The choice depends on your functional and aesthetic objectives.
Which technique is used for phalloplasty (radial flap, ALT — anterolateral thigh flap)?+
Two techniques are primarily used. The radial forearm free flap is the historical reference: it offers thin, supple skin ideal for integrating the urethra and shaping a naturally contoured phallus, but leaves a visible scar on the forearm. The anterolateral thigh flap (ALT) is an alternative that avoids the forearm scar at the cost of sometimes less fine skin texture. Dr. de Clermont-Tonnerre discusses the choice of technique with you during the consultation, taking into account your morphology, preferences and medical history.
How many surgical stages does a complete phalloplasty involve?+
A complete phalloplasty typically takes place over 2 to 3 separate surgical stages. The first and longest stage (6 to 8 hours) consists of creating the neo-phallus by microsurgical flap with urethral integration and simultaneous scrotoplasty. A second stage, performed 6 to 12 months later, involves implanting an erectile prosthesis (penile implant) to enable penetrative intercourse. Additional refinements (glansoplasty, scar revision, testiculoplasty) may constitute a third stage if needed. The complete pathway spans 1 to 2 years.
Can erections occur after phalloplasty? (erectile prosthesis)+
The neo-phallus created by phalloplasty has no natural erectile mechanism. To enable penetrative sexual intercourse, an erectile prosthesis (penile implant) is placed in a second surgical stage, approximately 6 to 12 months after the initial phalloplasty. There are two main types: inflatable hydraulic prostheses (discreet pump placed in the neo-scrotum) and semi-rigid (malleable) prostheses. Tactile sensitivity of the phallus, provided by microsurgical nerve connection, is generally preserved from the first stage.
What is the recovery time after phalloplasty?+
Recovery is lengthy and requires advance planning. Hospitalisation for the first surgical stage lasts 4 to 6 weeks in clinic, to monitor the microsurgical flap vascularisation and begin wound care. Time off work is at least 2 to 3 months for a sedentary role, longer for physical work. A urinary catheter is maintained for several weeks. The second stage (prosthesis) requires 3 to 5 additional days of hospitalisation.
What scars remain after phalloplasty by flap?+
With the radial flap, the donor site is the forearm: a significant scar covers the inner forearm and is usually covered by a thin skin graft taken from the thigh. This scar is visible but fades progressively over 12 to 18 months. With the ALT flap (thigh), the scar is on the outer thigh and can be concealed by clothing. Perineal scars (scrotoplasty, urethroplasty) are also present. All evolve favourably with time and appropriate care.
What is urethral lengthening and is it always performed?+
Urethral lengthening (urethroplasty) is the stage that enables standing urination after phalloplasty. It involves extending the native urethra to the tip of the neo-phallus using locally harvested or flap-integrated tissue. This is technically the most delicate step, as it carries the risk of urinary fistula or stenosis. It is performed in the majority of cases when standing urination is a patient objective, but may be deferred or excluded if contraindications exist. The decision is discussed during the pre-operative consultation taking into account your priorities and anatomy.

Patient testimonials

★★★★★

“Phalloplasty was the most important and demanding step of my transition. Dr. de Clermont-Tonnerre accompanied me with remarkable expertise and compassion. It is a complex procedure but the result is worth the considerable effort.”

Marc

★★★★★

“The surgeon took the time to explain each stage during the preparatory consultations. The ALD 31 process was made straightforward. I am 1 year post-op and the functional result is very satisfying. I finally live fully in harmony with my masculine identity.”

Tom

★★★★★

“The forearm scar was my main concern, but Dr. de Clermont-Tonnerre managed it very well. The neo-phallus is functional and natural. Impeccable medical follow-up throughout the entire pathway. I strongly recommend this expert in trans surgery in Paris.”

Julien

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See also

Gender surgery — all proceduresFacial feminisation (FFS)Top surgery (FtM)Vaginoplasty (MtF)Chest feminisationIntimate surgery
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